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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the first case of pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroids without surgery. A 27-year-old woman had been monitored for chronic headache 13 months after giving birth, associated with amenorrhea and galactorrhea. Cranial magnetic resonance imaging revealed a markedly enlarged pituitary gland with a suprasellar extension; the only biochemical abnormality was a mild hyperprolactinemia. Because of a putative diagnosis of prolactinoma, bromocriptine was prescribed at a dose of 5 mg daily, soon followed by the transitory appearance of menstruation. Two years later, panhypopituitarism was present and was revealed by acute adrenal insufficiency. Magnetic resonance imaging revealed that the pituitary mass was the same as previously described, but hormonal investigation showed evidence of complete hypopituitarism and no hyperprolactinemia. Nuclear antibodies were negative as well as other autoantibodies. Human leukocyte antigen serological Class II typing was DR3/DR4. Lymphocytic hypophysitis was then suspected; in the absence of visual complication and because this patient refused surgery, corticosteroids were attempted at a daily dose of 60 mg of prednisone for 3 months, progressively decreased for the next 6 months. Under this treatment, a gradual recovery of all pituitary hormones was observed and magnetic resonance imaging showed a reduction of two-thirds in pituitary mass. Five months after the end of corticoid treatment, our patient relapsed with panhypopituitarism and an increase of pituitary volume. She underwent steroid treatment, and a biopsy was performed and confirmed the diagnosis of autoimmune hypophysitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone: first case report. 780 Jan 42

The long-term efficacy and tolerability of CV 205-502, a non-ergot dopamine agonist with D-2 receptor affinity, were studied for up to 36 months in 16 patients with macroprolactinomas. Prolactin values were reduced in all cases, becoming either normalized or suppressed in 12. The pituitary tumor size was reduced in the 13 patients with an obvious tumor and visual function normalized in all six patients with initial defects. Concomitantly we observed improvement in gonadal function, galactorrhea, headache, libido and general well-being. Adverse reactions were experienced by 15 patients during dosage increment and caused one patient to discontinue the medication. Seven patients had persistent adverse effects which prohibited a dosage increase of CV 205-502, sufficient to normalize PRL levels in three. Two patients experienced serious adverse events, causing the discontinuation of treatment in one case. In eight patients treatment with CV 205-502 and bromocriptine could be compared. Three patients responded better to CV 205-502 than to bromocriptine treatment. Only one patient preferred bromocriptine to CV 205-502 for long-term treatment. We conclude that CV 205-502 is an effective and in most cases well-tolerated treatment for patients with macroprolactinomas. CV 205-502 is preferable to bromocriptine as an initial treatment and should also be tried in patients where treatment with bromocriptine has failed.
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PMID:Long-term treatment of macroprolactinomas with CV 205-502. 809 91

63 cases of hyperprolactinaemia (55 women and 8 men) were studied. Of the 55 women, 39 presented with infertility, while five were unmarried and had menstrual abnormalities. All eight men were partners of an infertile union. The principal modes of presentation of hyperprolactinaemia in women were infertility (74.6%) and menstrual disorders (27.6%). Galactorrhoea was evident in 28.6% and 10.7% had headache. There was no significant correlation between the level of prolactin and the duration of amenorrhoea. Changes in pituitary gonadotrophin levels were observed in 30.2% of cases, the common feature being an elevated LH level. Treatment with bromocriptine restored normal cycles, and the incidence of pregnancies was 38.5%. 14 normal infants were born and one patient miscarried.
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PMID:Hyperprolactinaemia and reproductive failure. 814 34

A 36-year-old woman with positional headache was found to have primary low cerebrospinal fluid (CSF) pressure syndrome and galactorrhea. The CSF pressure at lumbar puncture was not measurable. Magnetic resonance imaging demonstrated that the ventricle and cerebral sulcus were narrowed and the pituitary stalk was oppressed by the brain. Hyperresponsiveness of prolactin was noted after stimulation with thyrotropin-releasing hormone. These abnormalities disappeared with normalization of CSF pressure with the treatment. Galactorrhea was apparently due to oppression of the pituitary stalk by downward movement of the brain.
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PMID:Primary low cerebrospinal fluid pressure syndrome associated with galactorrhea. 832 18

A case of a 26-year-old woman with decreasing vision in her right eye, diplopia, headache, and galactorrhea is presented. Both CT and MR studies showed a large sphenoid fibroosseous lesion that had a ground glass appearance on CT and low-to-intermediate proton density and low T2-weighted and low T1-weighted signal intensities on MR. After contrast medium administration, this process diffusely enhanced on CT and MR. There was also an expansile mass in the sphenoid sinus that had intermediate proton density, high T2-weighted and low T1-weighted signal intensities compared with brain. This mass did not enhance but had an intensely enhancing, uniformly thin rim. The pathologic diagnosis was ossifying fibroma with a sphenoid sinus mucocele. There are only isolated reports in the literature of benign fibrosseous lesions causing mucoceles. This association is reviewed as are the findings in this case.
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PMID:Ossifying fibroma of sphenoid bone with coexistent mucocele: CT and MRI. 849 20

A case of primary low cerebrospinal fluid (CSF) pressure syndrome with galactorrhea is reported. Magnetic resonance imaging demonstrated diffusely enhanced meninges, edematous brain, and enlarged pituitary gland. Coincidental enlargement of pituitary gland and edematous brain due to low CSF pressure compressed the pituitary portal system. The low-perfused anterior lobe of pituitary gland would be the mechanism of galactorrhea.
Cephalalgia 1996 Apr
PMID:Primary low cerebrospinal fluid pressure syndrome with galactorrhea: findings at MR imaging. 866 79

Benign endocranial hypertension (BEH) is defined as a syndrome the clinical symptomatology of which includes elevated intracranial pressure without signs of focal injury of the brain. There were 55 BEH patients (52 female and 3 male patients). Changes of endocrine status were found to prevail among etiological factors, viz. pregnancy, obesity, galactorrhea-amenorrhea, hypothyrosis, ingestion of oral contraceptives. All the patients showed signs of intracranial hypertension (headache, vomit, conjested optical disks). The spinal fluid pressure was elevated, with the cellular and protein composition being normal. The condition was marked by benign course and favourable outcome.
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PMID:[The causes and clinical course of benign intracranial hypertension]. 881 35

Prolactinoma, a benign tumor originating from the lactotroph cells of the anterior pituitary, is responsible for signs and symptoms related to both hypersecretion of prolactin and tumor mass. Hyperprolactinemia frequently causes menstrual cycle disturbances, galactorrhea and infertility in women, sexual disorders in men. Microadenomas, characterized by a largest diameter less than 10 mm, may induce frontal headaches, and macroadenomas (more than 10 mm in diameter) may also impair visual function through chiasma compression. Treatment modalities include dopamine agonist therapy such as bromocriptine which allows normalization of prolactin levels, restoration of gonadal functions and tumor shrinkage in most cases. In microadenomas a definitive cure may be achieved by transsphenoidal total selective adenomectomy.
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PMID:[Prolactin-secreting adenoma]. 888 Nov 62

Cabergoline (CAB), a new, potent, and long-lasting PRL-lowering agent, was shown to be effective in tumoral hyperprolactinemia. The aim of this study was to investigate the effectiveness of CAB in patients with prolactinoma proven to be resistant to bromocriptine (BRC) and quinagolide (CV 205-502). Twenty-seven patients (19 macro- and 8 microprolactinomas) were treated with CAB at a weekly dose of 0.5-3 mg for 3-22 months. All patients were previously shown to be resistant to BRC, and 20 of them were resistant to CV 205-502 as well. Basal serum PRL levels before CAB treatment ranged from 108-3500 micrograms/L in macroprolactinomas and from 64-205 micrograms/L in microprolactinomas. Gonadal failure was present in all patients, whereas symptoms of tumor expansion, such as visual field defects and headache, were present in 10 of 27 patients. Eight macroprolactinomas had previously undergone surgery and/or radiotherapy. CAB treatment normalized serum PRL levels in 15 of 19 macroprolactinomas and in all 8 microprolactinomas. In 3 of the remaining 4 patients it caused a notable decrease in prolactinemia (89%, 80.5%, and 68.7% of the baseline). Only 1 patient was withdrawn from CAB therapy after 3 months at the weekly dose of 2 mg due to the absence of any significant clinical, hormonal, or radiological improvement. Gonadal function was restored in 18 of 27 patients, galactorrhea disappeared in 5 of 6 women, and headache improved in 7 of 8 patients. A significant tumor shrinkage was detected by computed tomography and/or magnetic resonance imaging in 9 macroprolactinomas and 4 microprolactinomas. CAB was well tolerated by all patients, except 6 who referred slight and short-lasting nausea, postural hypotension, abdominal pain, dizziness, and sleepiness at the beginning of treatment. In particular, CAB was well tolerated by 19 patients previously shown to be poorly tolerant to BRC and CV 205-502. In conclusion, CAB may represent, at the moment, the only successful therapy for prolactinoma-bearing patients resistant to BRC and CV 205-502, as it normalized PRL levels in 22 of 27 patients, reduced tumor size in 13 of 27 patients, and improved clinical symptoms in 25 of 27 patients in the present study.
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PMID:Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. 925 67

More than thirty types of tumors in the sellar region can mimic pituitary adenoma on, magnetic resonance imaging. When they exist, clinical manifestations are not necessarily highly contributive to diagnosis. Headache, visual impairment, signs of antepituitary insufficiency or possible dysmenorrhea with galactorrhea attributed to hyperprolactinemia due to compression of the dopaminergic axis are not specific and may be misleading. Clinical signs of diabetes insipidis and polyphagia are however suggestive of non-pituitary tumors. Consequently, high-resolution imaging (MRI) and sometimes particular diagnostic circumstances (post partum for hypophysitis for example, or breast cancer for metastasis) orient the diagnosis. More rarely tumor enlargement, for example in certain germ cell tumors, provides a clue.
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PMID:[Intra-sellar non-adenomatous expansive process]. 920 62


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